Code-type comparability of the MMPI and MMPI-2: analysis of recent findings and criticisms

The introduction of the MMPI-2 has stimulated studies of its comparability with the MMPI. Graham, Timbrook, Ben-Porath, and Butcher (1991) consider the congruence between MMPI-2 and MMPI code types substantial, but Dahlstrom (1992) has questioned their appraisal, criticizing their use of "well-defined" code types. Our own analysis supports Graham and colleagues' (1991) conclusions and provides reasons for favoring narrow code types (such as well- defined code types) over nonrestrictive ones. We also offer a brief historical review of MMPI code typology as background for our recommendation that future MMPI-2 research not be limited to studies of code-type correlates.     

A resolution to the interpretive dilemmas created by the Minnesota Multiphasic Personality Inventory 2 (MMPI-2)? A reply to Ben-Porath and Graham

In my original article (Strassberg, 1991) I described (1)some of the changes introduced by the MMPI-2, (2) possible interpretive dilemmas created by these changes, and (3) strategies for dealing with these dilemmas. In their reply to my paper, Ben-Porath and Graham (preceding paper) suggest that the differences between the MMPI-2 and the MMPI (1) are to be expected, (2) are less important than I imply, and (3) when they do occur, will almost always reveal the superiority of the MMPI-2. In this reply to Ben-Porath and Graham, I explain why, despite their reassurances, I continue to contend that interpretive dilemmas can exist when using the MMPI-2, but these should not deter us from using this instrument.     

How (not) to evaluate the comparability of MMPI and MMPI-2 profile configurations: a reply to Humphrey and Dahlstrom

Humphrey and Dahlstrom (1995) presented a study on the comparability of MMPI/MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles in which they concluded that "the bases for clinical interpretation derived from the MMPI and MMPI-2 profiles were sufficiently at variance to require different conclusions" [sic] (p. 2). In this brief critique, we identify procedural and data-analytical deficiencies that invalidate Humphrey and Dahlstrom's argument. Their blanket recommendation based on this argument, namely, that clinicians routinely plot both MMPI and MMPI-2 profiles, is unwarranted.     

Evaluating the similarity of MMPI-2 and MMPI profiles: reply to Dahlstrom and Humphrey

We review issues that have arisen in exchanges with Dahlstrom and Humphrey (Dahlstrom & Humphrey, 1996; Humphrey & Dahlstrom, 1995) about assessing the comparability of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the MMPI. We point out the limitations of Q correlations (without contending that D(2) is "the only legitimate function of profile comparability," as Dahlstrom and Humphrey, 1996, p. 350, claim we do), and explain why Dahlstrom and Humphrey's (1996) new Q-correlational results, correctly interpreted, are consistent with our own previous observations and conclusions. We stress again the importance of both overall profile elevation and profile "definition" in making code-type assignments. Nonrestrictive code types ignore these profile characteristics, and their use needlessly lowers MMPI-2/MMPI code-type congruences and raises the incidence of profile misinterpretations. Our recommendation of well-defined MMPI-2 code types stands.     

Evaluating the Similarity of MMPI-2 and MMPI Profiles: Reply to Dahlstrom and Humphrey

We review issues that have arisen in exchanges with Dahlstrom and Humphrey (Dahlstrom & Humphrey, 1996; Humphrey & Dahlstrom, 1995) about assessing the comparability of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the MMPI. We point out the limitations of Q correlations (without contending that D² is "the only legitimate function of profile comparability," as Dahlstrom and Humphrey, 1996, p. 350, claim we do), and explain why Dahlstrom and Humphrey's (1996) new Q-correlational results, correctly interpreted, are consistent with our own previous observations and conclusions. We stress again the importance of both overall profile elevation and profile "definition" in making code-type assignments. Nonrestrictive code types ignore these profile characteristics, and their use needlessly lowers MMPI-2/MMPI code-type congruences and raises the incidence of profile misinterpretations. Our recommendation of well-defined MMPI-2 code types stands.     

Assessing depression with the MMPI and MMPI-2

The usefulness of the MMPI (Hathaway & McKinley, 1951 ) and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) for diagnosing and assessing symptomatic depression has been the subject of considerable debate for a number of years. In this article, we review the relative contributions of the MMPI and MMPI-2 clinical and content scales in predicting depression. Positive predictive power, negative predictive power, and overall classification rate were computed for Scale 2 (D) of the MMPI and MMPI-2 and the Depression content scale (DEP) of the MMPI-2. Scale 2 (D) of both the MMPI and MMPI-2 appears to be moderately accurate in predicting depression. Although some studies suggest that the content scale DEP provides incremental validity over Scale 2 (D) of the MMPI-2, the results of this review indicate that the content scale DEP of the MMPI-2 does not exceed the diagnostic efficiency of Scale 2 in predicting depression.     

Seven issues in Conducting Forensic Assessments: Ethical Responsibilities in Light of New Standards and New Tests

The publication of a new ethics code for the American Psychological Association (1992), new guidelines (Committee on Ethical Guidelines for Forensic Psychologists, 1991), and two new versions of the Minnesota Multiphasic Personality Inventory (the MMPI-2, Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; and the MMPI-A, Butcher et al., 1992) provide an opportunity to review ethical aspects of forensic assessment. Seven major issues-appropriate graduate training, competence in the use of standardized tests, using tests that fit the task, using tests that fit the individual, administering tests correctly, using computers appropriately in forensic assessment, and assessing and reporting factors that may affect the meaning of test findings—are discussed. The revision of the MMPI is used to illustrate some of these issues.     

MMPI-2 in the inpatient assessment of women with eating disorders

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) reveals similar patterns across all Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) eating-disorder diagnoses. In this study, 550 women with eating disorders completed the MMPI-2. The 3 highest mean elevations for all eating-disorder diagnostic groups occurred on the same scales in the same order: 2, 7, and 3. The modal code for all groups was 2-7/7-2. However, multivariate analyses using the 16 validity and clinical scales, as well as the 27 content and supplementary scales, indicated that the MMPI-2 also distinguishes among eating disorders, especially in that patients with restricting anorexia report less psychopathology than other groups. These results are compared with the results of past eating-disorder research that used the older MMPI (Hathaway & McKinley, 1983).     

Psychometric characteristics of the MMPI-2 Cook-Medley Hostility scale

The Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) Cook-Medley Hostility scale (Ho) has been studied a great deal because of its relation to coronary disease and mortality. However, little research has been conducted with the Ho scale on the revised MMPI (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). This study examined the psychometric characteristics of the MMPI-2 Ho scale. Only nine of the original 50 Ho items were slightly changed in the revision. Ho scores were highly correlated with MMPI-2 scales CYN, K, TPA, and ASP, supporting the interpretation of Ho as a measure of cynicism. High correlations with other MMPI-2 scales also suggested that Ho is related to general psychopathology and negative affectivity. Male Ho scorers were rated by their spouses as hotheaded, bossy, demanding, and argumentative. For women, Ho scale scores were less strongly associated with ratings of overt hostility. Principal components analysis of Ho revealed four underlying dimensions: Cynicism, Hypersensitivity, Aggressive Responding, and Social Avoidance.     

Comparison of MMPI-2 and MMPI Clinical Scales and High-Point Scores Among Methadone Maintenance Clients

Methadone client volunteers completed the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1967) and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) on consecutive days. MMPI2 T-scores were lower by a mean of 4.7 on the clinical scales; when 5 points were added to MMPI-2 T-scores the mean difference was 2.3. Rank order of subjects on scale T-scores was not significantly different between the two instruments. High-point similarity for clinically elevated profile pairs ranged from 61% to 92%, depending upon definition of similarity.     

Predicting DMS-IV cluster B personality disorder criteria from MMPI-2 and Rorschach data: a test of incremental validity

Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs). In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed alimited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance (p <.05). Hierarchical regression analyses showed that both the MMPI and Rorschach data add incrementally in the prediction of DSM-IV borderline and narcissistic PD total criteria scores. The findings were less clear for the incremental value of Rorschach and MMPI-2 data in predicting the total number of DSM-IV histrionic PD criteria, which were best predicted by Rorschach data, and antisocial PD criteria, which were best predicted by MMPI-2 data. In addition to providing evidence of the incremental validity of Rorschach data, these findings also shed light on the psychological characteristics of the DSM-IV Cluster B PDs.     

Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder

The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.     

Predicting DSM-IV Cluster B Personality Disorder Criteria From MMPI-2 and Rorschach Data: A Test of Incremental Validity

Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs). In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed a limited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance (p < .05). Hierarchical regression analyses showed that both the MMPI and Rorschach data add incrementally in the prediction of DSM-IV borderline and narcissistic PD total criteria scores. The findings were less clear for the incremental value of Rorschach and MMPI-2 data in predicting the total number of DSM-IV histrionic PD criteria, which were best predicted by Rorschach data, and antisocial PD criteria, which were best predicted by MMPI-2 data. In addition to providing evidence of the incremental validity of Rorschach data, these findings also shed light on the psychological characteristics of the DSM-IV Cluster B PDs.     

The Minnesota Multiphasic Personality Inventory-2: A Review

The new version of the Minnesota Multiphasic Personality Inventory, the MMPI-2, is described and critiqued in this article. The MMPI-2 has many positive features such as updated items, new norms, additional validity scales, and additional clinical scales for diagnosing problems not addressed by the original MMPI. There are, however, also many negative features for this test such as problems with the compatibility of code types and the representativeness of the norm group. Much research needs to be done before accurate interpretations can be made for all MMPI-2 profiles and the full potential of the test is realized.     

Syndromal complexity, paradigm shifts, and the future of validation research: comments on Nichols and Rogers, Sewell, Harrison, and Jordan

In this comment, I address a number of the points raised in the reviews of the MMPI-2 Restructured Clinical (RC; Tellegen et al., 2003) Scales by Nichols (2006/this issue) and Rogers, Sewell, Harrison, and Jordan (2006/this issue), and I advocate for changes in assessment validation research. There is little evidence that the "syndromal complexity" Nichols ascribes to the original MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Clinical Scales is worth preserving. Although their construction does not constitute the paradigm shift claimed by Rogers et al., the RC Scales are promising, psychometrically defensible measures of core features of the original MMPI-2 Clinical Scales. However, validation of inferences from multiscale inventories such as the MMPI-2 is limited at present by a disconnection between the integrative manner in which MMPI-2 profiles are interpreted and the scale-by-scale nature of most MMPI-2 validation studies. Q-sort procedures show promise for operationalizing integrated MMPI-2 interpretations, with both research and teaching applications.     

Four-Month Test-Retest Reliability of the MMPI-2 With Normal Male Clergy

This investigation examined the test-retest coefficients and absolute score changes with the Basic, Supplementary, and Content scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants were 111 active male clergy who were not receiving mental health services at the time of their participation and who completed the MMPI-2 on two occasions separated by 4 months. A repeated measures multivariate analysis of variance for the three groups of scales revealed nonsignificant changes in mean T scores. In general, the test-retest coefficients obtained were similar to those reported in the MMPI-2 manual by Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer (1989) and by Spiro, Butcher, Levenson, Aldwin, and Bosse (1993). Increases or decreases of 3 to 6 T-score points were observed for the majority of the scales, and instances in which T-score changes exceeded 10 points were observed on every scale. In sum, the test-retest reliability of the majority of MMPI-2 scales, as represented in this nonclinical sample, appears acceptable and compares favorably with the original MMPI.     

MMPI-2 profiles of women with eating disorders in a Dutch day treatment sample

In this study, we examined the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI-2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI-2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI-2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI-2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI-2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.     

Comparability of MMPI-2 scales and profiles over time

This study investigated Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scale and profile comparablilty for MMPI-2 profiles completed on 2 separate occasions by mental health patients receiving treatment at a Veterans Affairs Medical Center (n = 114). Patients were predominantly men (96.5%), with an average age of 44.08 and an average of 12.39 years of education at the time of initial testing. MMPI-2 tests were completed on 2 separate occasions as a routine part of treatment with a mean interval between test administrations of 688 days. Findings were analyzed for the complete sample and for 3 subsamples with different test-retest intervals. MMPI-2 scale test-retest correlation coefficients for the entire sample ranged from .48 to .69 for the Basic scales, .49 to .80 for the Supplementary scales, and .56 to .78 for the Content scales with scale high-point agreement = 38.60%, high 2-point agreement = 16.67%, and high 3-point agreement = 19.30%. High-point agreement for subsets of participants with well-defined high points, 2-points and 3-points was 41.07%, 27.50%, and 25.93% respectively. Pearson r correlation coefficients for T scores across the Basic scales for pairs of profiles averaged .78, suggesting similarity of profile shape across testing occasions. MMPI-2 profiles were also examined in relation to Skinner and Jackson's 3 modal MMPI profile types.